Klebsiella pneumoniae Renal Abscess Syndrome: A Rare Case with Metastatic Involvement of Lungs, Eye, and Brain

We describe a rare case of Klebsiella pneumoniae renal abscess with metastatic spread leading to endopthalmitis, pulmonary cavitary lesions, and cerebral emboli in a 41-year-old Hispanic female with diabetes mellitus who presented with a four-to-five-day history of fevers, headache, eye pain, and vomiting. She was treated with IV antibiotics and made a gradual but full recovery. 1. Introduction Klebsiella pneumoniae, a member of the Enterobacteriaceae family, is a virulent Gram negative organism that causes nosocomial infections. It has a higher tendency to infect immunocompromised patients including those with diabetes. Commonly attributed infections to Klebsiella pneumoniae include urinary tract infections (UTIs) and pneumonias. Rarely, incidence of abscess formation secondary to Klebsiella pneumonia infection has been reported in organ like liver, lung, and brain [1]. In addition, certain serotypes of Klebsiella pneumoniae, particularly K1 and K2, have been reported to involve secondary areas of the body through metastatic spread from the primary abscess [1–8]. Klebsiella liver abscess presenting as a widely metastatic invasive syndrome has been reported in South East Asia [1, 2]. However, only a few cases of renal abscess with metastatic spread have been reported [2–8]. In this report, we describe a rare case of Klebsiella pneumoniae renal abscess with metastatic lesions to the brain, eyes, and lungs. 2. Case Report A 41-year-old Hispanic female with a history of type 2 diabetes mellitus presented with four-to-five days of progressively worsening fever, headache, right eye pain, blurred vision, nausea, and vomiting. She also complained of shortness of breath and pleuritic chest pain over the last twenty four hours. On examination, a hypopyon was visualized in the anterior chamber of right eye, and bilateral crackles were heard on lung auscultation. No significant weakness or numbness was found on neurological exam. Complete blood count showed leukocytosis with neutrophilic predominance. Urine analysis was consistent with urinary tract infection. Her condition deteriorated at this point, and she became confused and disoriented. Cultures were obtained, and she was started on empiric intravenous antibiotics (Vancomycin and Zosyn). Ophthalmology service was consulted, and she was treated with intravitreal injection of vancomycin and ceftazidime. MRIs of her brain and orbits were obtained which showed inflammatory changes surrounding the right ocular globe, consistent with endopthalmitis (Figure 1(a)). There were also multifocal regions of increased